the star

Safe sex goes out the window

World Aids Day is an opportunity for people worldwide to unite in the fight against HIV. Unfortunately, South Africans seem to be complacent about protecting themselves against HIV, says the writer Picture: Motshwari Mofokeng

HIV rates are creeping up as South Africans lose their fear of contracting the virus that has no cure, writes Kerry Cullinan.

Imagine if every person who passed the matric National Senior Certificate last year was infected with HIV? Well, that’s close to the number of South Africans infected in 2012 – some 469 000 people.

South Africans have pushed safe sex practices out of the window in much the same way that Ugandans and residents of San Francisco did once they felt HIV was under control.

Like South Africa, these communities witnessed high death rates from Aids – yet it wasn’t enough to make them permanently change their sexual behaviour.

Once the risk seemed under control, it was unprotected sex as usual.

The National HIV Prevalence, Incidence and Behaviour Survey for 2012, released this week by the Human Sciences Research Council, reports a 2 percent increase in HIV infection in the past four years – and plummeting condom use, increases in multiple sex partners and more boys having sex before they turn 15.

HIV prevention is working only among young people aged 15 to 24, (where HIV infection has dropped from 10 percent in 2005 to 7.1 percent) and between HIV-positive mothers and their babies.

Many of these young people are exposed to safe sex messages in schools. Meanwhile, antiretroviral medicine prevents HIV-positive mothers from passing the virus on to their babies, so this intervention does not need the women to change their sexual behaviour.

As South Africans, we seem to have dropped our guard about HIV because we either believe HIV to be a distant threat or because we no longer fear infection because we know it can be easily treated. Far and wide, South Africans have faith in our energetic health minister and believe that HIV is “under control”. In fact, three-quarters of the 38 000 people interviewed in the survey did not think they were at risk of HIV.

At the survey’s launch, Health Minister Aaron Motsoaledi noted that people knew that HIV could be controlled by one pill a day, perhaps making infection less scary.

“There is always the risk that if you lower the stigma of HIV, you lower the concern,” added Science and Technology Minister Derek Hanekom at the launch.

Perhaps the sex has also been taken out of HIV. After all, doctors are referring to it as a chronic disease just like diabetes and hypertension.

But HIV is not like other chronic diseases. It is primarily sexually transmitted, and if people are to avoid infection, they need to practise safe sex.

Yet amid the hype about treatment, the link between HIV and sex seems to be getting lost. We know about antiretrovirals and how to take them – yet only about 27 percent of people interviewed knew how HIV was transmitted.

Yet about 6.4 million people are now infected with HIV – including 36 percent of women aged 30 to 34 and 28.8 percent of men aged 35 to 39.

We cannot sustain a treatment programme that is growing by almost half-a-million new HIV infections a year.

As Wits University’s Professor Francois Venter points out, for every three people newly infected, only two people are getting antiretroviral treatment.

Given the failure of efforts to curb new infections, some scientists say it is time to consider the biomedical solution – putting every HIV-positive person on ARVs. People on ARVs with undetectable viral loads are virtually non-infectious.

The Human Sciences Research Council’s Thomas Rehle says there is no longer a debate internationally about whether “treatment as prevention” can work – but rather how to implement it.

But this would be a massive, costly exercise – and in the meantime, the condom remains a powerful weapon against HIV.